{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:51:16Z","timestamp":1782489076449,"version":"3.54.5"},"reference-count":19,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,3,12]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:p>This report describes a child diagnosed with a presentation consistent with paediatric acute-onset neuropsychiatric syndrome (PANS), accompanied by obsessive-compulsive symptoms and trichotillomania. A school-aged girl in middle childhood developed sudden-onset washing rituals, contamination fears, hair-pulling behaviour and progressive academic decline shortly after a severe throat infection. Her symptoms included prolonged handwashing, repetitive utensil cleaning and recurrent hair pulling resulting in a patch of incomplete alopecia. Psychiatric assessment confirmed moderate obsessive-compulsive symptom severity, and dermatological evaluation supported a behavioural origin of hair loss consistent with trichotillomania. Comprehensive investigations including blood tests, neuroimaging, electroencephalography, abdominal ultrasound and cognitive testing were unremarkable except for elevated anti-streptolysin O (ASO) titres, indicating a past streptococcal illness. She was treated with fluoxetine, behavioural therapy and family psychoeducation, leading to a gradual reduction in compulsive behaviours, decreased hair pulling, improved daily functioning and early hair regrowth over 3\u2009months.<\/jats:p>","DOI":"10.1136\/bcr-2025-271869","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T16:05:25Z","timestamp":1775145925000},"page":"e271869","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Paediatric acute-onset neuropsychiatric syndrome (PANS) with trichotillomania"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4572-6054","authenticated-orcid":false,"given":"Christopher","family":"Peter","sequence":"first","affiliation":[{"name":"Psychiatry, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayuresh Shamsunder","family":"Pavaskar","sequence":"additional","affiliation":[{"name":"Dermatology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, UP, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akanksha","family":"Sharma","sequence":"additional","affiliation":[{"name":"Psychiatry, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul Qadir","family":"Jilani","sequence":"additional","affiliation":[{"name":"Psychiatry, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"key":"2026062608151922000_19.4.e271869.1","doi-asserted-by":"publisher","DOI":"10.2147\/NDT.S362202"},{"key":"2026062608151922000_19.4.e271869.2","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2016.0148"},{"key":"2026062608151922000_19.4.e271869.3","unstructured":"Pediatric acute-onset neuropsychiatric syndrome (pans): clinical report | pediatrics. 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DOUBLE jeopardy - a case of trichotillomania and intellectual disability."},{"key":"2026062608151922000_19.4.e271869.11","unstructured":"Priya DMM , Kavi DRK , Talluri B , et al . n.d. Trichotillomania with Mental Retardation: A Case Report."},{"key":"2026062608151922000_19.4.e271869.12","doi-asserted-by":"crossref","first-page":"78","DOI":"10.61882\/goums.26.4.78","article-title":"Trichotillomania Disorder in a Child with Intellectual Disability and the Efficacy of Habit-Reversal Training Techniques: A Case Report","volume":"26","author":"Yaghoobi","year":"2024","journal-title":"J Gorgan Univ Med Sci"},{"key":"2026062608151922000_19.4.e271869.13","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.60.5.517"},{"key":"2026062608151922000_19.4.e271869.14","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.v61n0111"},{"key":"2026062608151922000_19.4.e271869.15","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2016.0105"},{"key":"2026062608151922000_19.4.e271869.16","doi-asserted-by":"crossref","DOI":"10.3389\/fped.2021.746639","article-title":"Diagnostic Approach to Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (PANDAS): A Narrative Review of Literature Data","volume":"9","author":"Prato","year":"2021","journal-title":"Front Pediatr"},{"key":"2026062608151922000_19.4.e271869.17","unstructured":"Obsessive-compulsive and related disorders . 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